Credentialing & Enrollment Coordinator

The Jewish Board • New York, NY

5d • Remote

About The Position

The Credentialing & Enrollment Coordinator manages end-to-end credentialing, re-credentialing, and payer enrollment for medical and behavioral health providers at The Jewish Board. This is a remote offshore role based in Mexico, Peru, or Colombia, focused on maintaining compliance with federal and New York State payer regulations, including PECOS, OPRA, and state mental hygiene frameworks. The Coordinator uses AI software and advanced databases to track credentialing, assess regulatory changes, and streamline workflows, while coordinating with New York-based Human Resources, Recruitment, and Program Directors to onboard employees and protect billing relationships across clinic locations.

The role includes enrolling providers with federal, state, and commercial payers; managing New York State regulatory workflows; credentialing diverse clinical specialties; verifying licenses and other qualifications; and collaborating with HR, Talent Acquisition, Clinical Operations, and billing teams. It also involves maintaining credentialing databases and Tableau dashboards, using Claude and Microsoft Copilot to support regulatory and administrative work, and investigating enrollment-related claim rejections. Other projects may be assigned by the Senior Director.

Requirements

• At least 3–5 years of healthcare credentialing and provider enrollment experience.
• Documented exposure to U.S. healthcare insurance, behavioral health, mental health clinics, or social services structures.
• C1/C2 professional-level written and spoken English.
• Mastery of PECOS, NPPES, and CAQH ProView.
• Familiarity with New York State Medicaid, eMedNY, OMH, and OASAS provider enrollment registry workflows.
• Deep understanding of U.S. healthcare compliance, NCQA standards, and government billing regulations.
• Ability to maintain focus while reviewing high volumes of digital data, regulatory documents, and complex spreadsheets.
• Ability to multitask across software platforms and AI tools efficiently in a remote setting.
• Reliable, high-speed, secure internet connection capable of supporting digital databases, video conferencing, and AI tools.
• Ability to work prolonged periods sitting or standing at a desk and working on a computer.

Nice To Haves

• Bachelor’s degree in Healthcare Administration, Human Services, Business, or a related field; equivalent direct experience is fully considered.
• Certified Provider Credentialing Specialist (CPCS) designation.
• Certified Professional Medical Services Management (CPMSM) designation.
• Documented comfort using Tableau for reporting.
• Experience using generative AI platforms, specifically Claude and Microsoft Copilot.

Responsibilities

• Coordinate initial enrollment, revalidation, and maintenance with federal, state, and commercial payers, including PECOS and OPRA compliance.
• Manage New York State enrollment workflows through eMedNY, OMH, and OASAS portals, keeping current with applicable regulatory bodies.
• Manage credentialing portfolios for behavioral health and medical providers, including LCSWs, LMHCs, MDs, PAs, and NPPs, in alignment with NYSED licensing requirements.
• Coordinate with HR, Talent Acquisition, and Clinical Operations to collect pre-employment documentation and accelerate credentialing verification for new hires.
• Maintain credentialing databases and use Tableau to create, update, and present dashboards on credentialing pipelines, expiration timelines, and application aging.
• Use and adapt generative AI tools, specifically Claude and Microsoft Copilot, to summarize changing healthcare regulations, draft compliance correspondence, and automate administrative tasks.
• Investigate and audit provider enrollment-related claim rejections with the billing team and make corrections in clearinghouses or state payer registries.
• Conduct primary source verification of state licenses, DEA certificates, malpractice coverage, and education history in accordance with NCQA, New York State Department of Health, and state oversight board guidelines.
• Complete other projects assigned by the Senior Director.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed